Changes in sexual behavior, PrEP adherence, and access to sexual health services due to the COVID-19 pandemic among a cohort of PrEP-using MSM in the South

Abstract

BackgroundThe COVID-19 pandemic has had unforeseen consequences on the delivery of HIV and STD prevention services. However, little is known about how the pandemic has impacted PrEP-using men who have sex with men (MSM).MethodsData come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered ten surveys in total, including one ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n=56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effects regression models, we also analyzed data from the larger cohort (n=78) and document how sexual behaviors and PrEP use varied longitudinally focusing on three months: February (pre-pandemic), April (early pandemic), and June (later in the pandemic).ResultsA fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally—number of male sexual partners, anal sex acts, condomless anal sex, oral sex (all measured in the past 2 weeks)—there was a significant decrease from February to April followed by a significant increase from April to June.DiscussionOur findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.

Projected HIV and Bacterial Sexually Transmitted Infection Incidence Following COVID-19–Related Sexual Distancing and Clinical Service Interruption

“…Empirical data suggests a wide heterogeneity of changes in sexual activity during initial COVID-19 restrictions in March 2020 [ 7 , 8 ]. However, fewer studies have characterized the timing of behavioral rebounds; some have suggested a return to pre–COVID-19 levels starting as early as June 2020 [ 9 , 10 ]. Our model suggests that such a transient change will have no substantive impact for HIV and only a minor impact for STIs.…”

“…These were reduced on a relative scale individually and jointly. We selected the joint 50% relative reduction in sexual behavior and clinical services as a key scenario to highlight in figures based on empirical data suggesting upwards of this level of change [ 7 , 9 ].…”

“…In primary scenarios, service interruption lasted for 18 months and sexual distancing either for 18 months or 3 months. The 18-month window was selected based on predictions of the timeline for COVID-19 vaccine deployment (roughly, Summer 2021); the shorter 3-month sexual distancing window was selected based on empirical data suggesting a more rapid behavioral rebound of sexual partnerships as early as June 2020 [ 9 , 10 ]. Sensitivity analyses varied the duration of both.…”

“…Use of clinical HIV/STI services has also declined among MSM in the United States. Categories of reduced services include HIV/STI diagnostic screening (range, 25%–85%), use of HIV preexposure prophylaxis (PrEP; range, 20%–72%), and retention in HIV care (range, 25%–45%) [ 7 , 9 ]. Providers have partially addressed these interruptions by replacing in-person clinical visits with telehealth services [ 11 ], but these tools may be less available to people with the greatest need [ 12 ].…”

Wave the Yellow Flag: Why We Should Prioritize Routine Human Immunodeficiency Virus and Sexually Transmitted Infection Care Now

“…Yet, COVID-19 was quickly spreading across the globe leaving horrific rates of illness, hospitalizations, and death in its wake. To protect patients and staff, some HIV and sexual health clinics limited business operations or provided services only virtually [ 4 , 5 ]. In essence, they opted for a population-level quarantine—effectively waving the black flag by selecting this blunt yet powerful tool [ 4 , 5 ].…”